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101 Cards in this Set
- Front
- Back
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Fatty infiltration of the liver can be caused by a (high / low) fat diet, a (high / low) protein diet, and yo-yo dieting.
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1. high
2. low |
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Fatty infiltration may be either _____ (confined to one area) or _____ (spread throughout the liver)
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1. focal
2. diffuse |
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Areas of normal tissue which are near areas of fatty infiltration are referred to as _____.
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spared
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Fatty liver tissue is (bright & reflective / dark & dull) and (granular / smooth) in texture
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1. bright & reflective
2. granular |
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A fatty liver results in (less / more) sound wave attenuation
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more
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A fatty liver may result in an (enlarged / shrunken) liver
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enlarged
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With a fatty liver, the portal vein walls will be (obscure / prominent)
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obscure (because their fatty walls no longer stand out, since there is fat in the surrounding areas as well)
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Liver abscesses can be caused by ____, ____, or ______.
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bacteria
fungi parasites |
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The most common type of liver abscess is called a ______ abscess, and is caused by ______.
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pyogenic
bacteria |
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"pyo" implies the presence of ____
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pus
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The most common cause of pyogenic abscesses is the _____ bacterium, which travels through either the ___ ___ or the ___ ____.
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e. coli
portal vein biliary ducts |
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Pyogenic abscesses usually occur in the ____ lobe.
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right
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E. coli produces ___, resulting in _____ ____ and ____ _____.
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gas
echogenic foci dirty shadowing |
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Pyogenic abscesses are most commonly found in (healthy / immuno-depressed) patients
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immuno-depressed
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Patients with pyogenic abscesses will often present with:
- (fever / no fever) - (high / normal) WBC - (abdominal pain / no abdominal pain) - (anorexia / bloating) |
1. fever
2. high 3. abdominal pain 4. anorexia |
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How often does a pyogenic abscess resolve itself?
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5-10%
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A pyogenic abscess (may / will not) spread to neighboring organs.
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may
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A pyogenic abscess (may / will not) cause massive liver necrosis.
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may
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A pyogenic abscess (may / will never) persist for a long period of time.
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may
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A pyogenic abscess (may / will never) be caused by an infected cyst or surgical trauma.
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may
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In newborns, pyogenic abscesses are usually related to _____.
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umbilical cord infections
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The appearance of a pyogenic abscess (may change / will remain constant) over time
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may change
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Newly formed pyogenic abscesses will often appear (cystic / non-cystic), will be (encapsulated / non-encapsulated), will have (irregular / regular) walls, and (no / some) septations.
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1. cystic
2. encapsulated 3. irregular 4. some |
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An aging pyogenic abscess will often produce ___, producing small, bright echoes, with ____ ____.
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1. gas
2. dirty shadowing (See pp 77,78) |
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Debris such as pus, bacteria, and dead cells in a pyogenic abscess will look like ____ inside the fluid.
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1. sand
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Pyogenic abscesses exhibit (decreased / increased) vascularity in the periphery, and (decreased / increased) vascularity in the center.
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1 increased
2. decreased |
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Most pyogenic abscesses will be drained by ___, guided by ultrasound.
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Fine needle aspiration (FNA)
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Pyogenic abscesses will show (high / low) Resistive Index (RI).
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high
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The standard treatment for pyogenic abscesses is _______.
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antibiotics
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A complication of aspiration, as well as of other procedures involving incisions into the abdominal wall, are _____, which are a _____ of tissue, which may constrict the _____ or other organs.
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adhesions
bridge GI tract |
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Echinococcosis is a ______ abscess, caused by the larval stage of Echinococcus _____, E. _____, or E. _____i.
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parasitic
granulosis multilocularis vogeli |
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E. granulosus is a _(type of parasite)_ species which produces ____cystic lesions, and is prevalent in areas where ____ are raised in association with ____, such as (multiple countries and regions)
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tapeworm
unilocular livestock dogs Australia, Argentina, Chile, Africa, eastern Europe, the Middle East, New Zealand, and the Mediterranean region. |
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E. _______, which causes _____ _____ lesions, is found in ____ climates.
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multilocularis
multilocular alveolar (lung) cold |
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E. vogeli causes ____ _____disease and is found only in _____.
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polycystic hydatid (containing tapeworm larva)
central and south america |
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Parasitic cysts most commonly occur in the ____ and _____.
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liver
lungs |
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Germinating cystic structures are called ______ ______.
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brood capsules
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Echinococcal cysts generally remain _____ until their expanding size or their space-occupying effect in an involved organ elicits symptoms.
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asymptomatic
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Patients with hepatic echinococcosis who are symptomatic most often present with ____ ___ or a ____ ____ in the right upper quadrant.
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abdominal pain
palpable mass |
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Patients with hepatic echinococcosis who are symptomatic may present with ______ and/or ______, as well as increased lab values of ___ ___, due to biliary blockage resulting from the neighboring enlarged mass.
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jaundice
"too many tubes" total bilirubin |
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Rupture or leakage from a cyst may produce ____ or _____.
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fever
pruritus (itchy skin) |
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Pulmonary hydatid cysts may rupture into the _______ or ______ and produce ____, _____, or _______.
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bronchial tree
peritoneal cavity cough chest pain hemoptysis (the coughing up of blood) |
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The 4 stages of cyst formation are:
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1. Simple fertile cyst
2. Daughter cyst formation 3. Cyst with detached endocyst 4. Calcified cyst (See pp 93-96) |
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What are the two layers of a simple fertile cyst?
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1. The endocyst (inner layer)
2. The pericyst (outer layer) |
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The endocyst produces ____ and ___ _____.
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fluid
new larvae |
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The pericyst produces a _____ with multiple fine, internal echoes called ___ ____.
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fluid
hydatic granules |
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During daughter cyst formation, a daughter cyst will be seen as ____ ____ within a large cyst.
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multiple sepatations
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During the stage of "Cysts with a detached endocyst", the endocyst will be seen as ____ ____ ____ within a large cyst, surrounded by fluid.
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undulated (moving) membranes
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During which stage do the septations separate into separate cysts?
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Cysts with a detached endocyst
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What is the term for endocysts when the undulated membrane has closed?
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Calcified cysts
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What replaces the fluid in a calcified cyst?
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Calcium
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How does a calcified cyst appear sonographically?
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The calcifications will be echogenic.
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What is the key sonographic distinguishing factor between a pyogenic abscess and an ecchinoccoccal parasitic infection?
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A pyogenic abscess will not contain septations or daughter cysts.
A parasitic cyst will contain septations and/or daughter cysts. |
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What three areas of the body are affected by flukeworm infections?
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1. intestines
2. liver (spread from intestines through portal system) 3. urinary tract |
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Flukeworms (can / cannot) penetrate intact skin with their suckers.
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can
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Human ______ is caused by five species of this parasitic trematode.
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Schistosomiasis
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What is the pathogenesis (manner of development) of schistosomiasis?
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1. Granuloma formation
2. Liver fibrosis 3. Urinary system involvement (Debra said be aware of this slide) |
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Granulomas associated with schistosomiasis are formed in the ____ ____, resulting in hepatomegaly.
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liver sinusoids
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Granulomas may cause portal blockage, resulting in formation of ____ ____ in the area of the ____. These are known as ______ ______.
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collateral pathways
GEJ esophageal varicies |
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What is a fibrotic lesion?
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A thickened, hyperechoic area
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Liver fibrosis resulting from schistosomiasis can be seen in areas of ____ _____, and particularly in the ____ _____.
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granuloma formation
portal tracts |
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What liver disease can occur as a result of schistosomiasis?
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cirrhosis
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Granulomas may also cause _____ blockage
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urinary
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Urinary blockage is sonographically evident as ______ areas in the kidneys.
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anechoic
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Granuloma formation may also cause depositions of _____ within and deterioration of the ___ ___.
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calcium
bladder wall |
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The 3 clinically visible stages of schistosomiasis invasions are:
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1. Dermatitis (swimmer's itch)
2. Katayama fever 3. Chronic schistosomiasis (symptoms are dependent upon species of schistosoma |
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What are the 3 symptoms of Katayama fever?
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1. Fever
2. Generalized lymphadenopathy (lymph node disease) 3. Hepatosplenomegaly (Debra said we need to know these) |
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Patients with schistosomal liver disease may have right-upper-quadrant _____ pain during the hepatomegaly phase, which may move from the ___ to the ___ as splenomegaly progresses.
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“dragging”
RUQ LUQ (Debra said to know this) |
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________ is the most common cause of death by a parasite, worldwide.
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schistosomiasis
(Debra said this was the most important takeaway from this section) |
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How will portal blockage by granulomas be sonographically visible?
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The smaller portal veins, which are normally sonographically invisible, will become blocked, making them enlarged and sonographically visible.
(Debra said to know this) |
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What is the most common location of sonographic evidence of portal blockage due to schistosomiasis granulomas?
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The porta hepatis
(Debra said to know this) |
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With schistosomiasis, the liver is initially enlarged, but once the condition becomes chronic, the liver ______, resembling ______, except without the surface nodularities.
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atrophies
cirrhosis (Debra said to know this) |
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Schistosomiasis typically results in portal hypertension, which is sonographically visible as enlargement of the ___ ___ ___, and ____ flow in that vein.
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main portal vein
reverse (Debra said to know this) |
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________, or an ____ ____, is an infection with the intestinal protozoan Entamoeba histolytica.
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Amebiasis
amebic abscess |
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About 90% of amebiasis infections are _____.
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asymptomatic
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Amebiasis is acquired by ingestion of _____ contaminated water, food, or hands.
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fecally
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Amebiasis is the ____ most common cause of death from parasitic disease
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third
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Amebiasis results in liver _____ with ____ centers
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abscesses
anechoic |
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An amebic abscess produces a ____ or ___ shaped lesion.
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round
oval |
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An amebic abscess will not have a prominent ____.
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wall
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An amebic abscess will be (hyperechoic / hypoechoic) to the liver parenchyma.
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hypoechoic
(See P 136) |
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An amebic abscess will produce low-level _____.
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echoes
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An amebic abscess will produce distal _____ _____.
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acoustic enhancement
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An amebic abscess will usually occur in the ____ lobe, and often will be close to the _____.
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right
diaphragm |
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What are the 4 typical sonographic appearances of candidiasis?
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1. Wheel within a wheel - hypoechoic in the center and on the outside, hyperechoic in the middle.
2. Bulls-eye lesions: hyperechoic center, hypoechoic rim. 1-4 cm diameter. Present when WBCs return to normal levels. 1-4 cm in diameter. (See P 144) 3. Hypoechoic (the most common type) 4. Hyperechoic (involves calcifications) |
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Why are contrast materials used?
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They create microbubbles, which will help expose and characterize certain abnormalities
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What are the two most common contrast agents used in the abdomen (in Europe and Asia, but not the US)?
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1. Definity
2. Optison (Debra said to know these) |
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Using a contrast material, how will a malignant mass appear differently from a benign mass?
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Malignant masses tend to form their own, unique vascular supply, whereas benign masses rely on the normal supply.
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Alchoholic liver disease can lead to what 3 other diseases?
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1. Fatty liver
2. Alcoholic hepatitis 3. Cirrhosis |
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90% of binge and chronic drinkers develop ____ ____.
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fatty liver
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A small % of binge and chronic drinkers develop ___ ____, which is a precursor to ____.
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alcoholic hepatitis
cirrhosis |
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Which gender is more susceptible to alcoholic liver disease?
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Females
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What are the most common causes of cirrhosis?
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Hepatitis B
Hepatitis C Alcohol abuse |
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What 4 complications can occur with cirrhosis?
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1. Edema / ascites
2. Infections 3. Hepatic encephalopathy (brain disease) 4. Massive bleeding from esophageal or gastrointestinal varices (Debra said to know these) |
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Cirrhosis is a risk factor for developing ___ ___ ___.
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Alchoholic liver disease
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If no liver damage has yet occurred, cessation of drinking can result in _____ of the liver to a healthy state.
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normalization
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What are the early sonographically visible indicators of cirrhosis, with regard to liver size and echogenicity?
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1. Hepatomegaly
2. Hyperechoic 3. Coarse texture (See P 173) |
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What are the later sonographically visible indicators of cirrhosis, with regard to liver size and echogenicity?
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1. Liver atrophy
2. Hypoechoic 3. Coarse texture 4. Vascular structures not well visualized 5. Irregular contour 6. Ascites (See P 174) |
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A normal sized caudate lobe is ___ to ___ % the size of the right lobe
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50 to 65 %
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What should the normal right lobe / left lobe ratio be?
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< 1.3
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What measurement constitutes portal vein hypertension?
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5 to 10 mm Hg greater than normal
(Debra said to know this) |
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Is the caudate lobe more or less subject to atrophy with cirrhosis?
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It is less subject, because it has its own blood supply.
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